Job Description

Reasonable Accommodations Statement
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the
essential functions.

Essential Functions Statement(s)

• Monitor, record, and report symptoms and changes in patient condition.
• Provide RN back-up for telephonic triage and intervention as needed.
• Perform skilled nursing and/or courtesy visits as indicated.
• Maintain accurate, detailed clinical documentation within required timeframes.
• Consult and coordinate with physicians, facilities, and interdisciplinary team.
• Educate patients and caregivers on disease management and prevention.
• Inform physician, supervising (On-Call RN), and DON of significant changes in patient condition.
• Maintain infection control standards.
• Perform other duties as assigned by management.

PERFORMANCE METRICS - REHOSPITALIZATION PREVENTION

• Contributes to agency 30-day hospital readmission rate targets as established by leadership.
• Demonstrates appropriate clinical escalation to prevent avoidable ER visits.
• Accurately identifies and intervenes on red-flag symptoms (CHF weight gain, COPD exacerbation, hyper/hypoglycemia, infection indicators, etc.).
• Ensures timely physician and supervising (on-call RN) notification for significant changes in condition.
• Provides evidence-based patient education during crisis calls and visits to reduce recurrence.
• Maintains 100% compliance with on-call response time expectations.
• Completes documentation within required timeframes to ensure continuity of care and risk mitigation.
• Participates in case review or QAPI meetings as needed when after-hours events result in hospitalization.

TIME FRAMES

• Documentation for each visit must be completed within 24 hours of the visit unless extenuating or unforeseen circumstances occur.
• On-Call Response Expectations:
• Must be immediately available by phone during assigned on-call hours.
• Return patient/caregiver and/or supervising/on-call RN calls within 15 minutes.
• If a skilled visit is required, respond to the patient’s home within 2 hours when feasible; no later than 4 hours unless otherwise directed by physician or immediate supervisor.
• Activate emergency medical services immediately for life-threatening symptoms.
• Communicate all after-hours activity to the DON by next business day.

SKILLS & ABILITIES

Education: Nursing Degree or Practical Nursing Program Graduate

Experience: One year LPN clinical experience required. Home Health or related experience preferred.

Computer Skills: Proficiency in electronic clinical documentation systems, general computer applications, and professional email communication.

Certificates & Licenses: Active Louisiana LPN License; Current BLS Certification; Valid Louisiana driver’s license.

WORK ENVIRONMENT

Provides care in patient homes and community settings throughout the assigned service area. Requires remote documentation and may require occasional in-office work for meetings, training, or administrative purposes